Comparative study between aperture and suspensary fixation of hamstring autografts on femoral side in ACL reconstruction: clinical and radiological outcome assessment

Abstract

<p class="abstract"><strong>Background:</strong> Arthroscopically aided anterior cruciate ligament reconstruction using hamstring graft can be fixed to femoral condyle by suspensory and aperture fixation methods. The following study was undertaken to investigate whether there is any difference in functional outcomes with these fixation methods as measured by the Lysholm knee score and to determine tunnel widening post operatively with these two methods and does it affect the functional outcome.</p><p class="abstract"><strong>Methods:</strong> 50 patients of clinically and radiologic ally diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft with suspensory (n=25) and aperture (n=25) fixation methods on femoral side. They were compared post operatively with Lysholm score, clinical laxity tests and percentage of tunnel enlargement using computed tomograms at 01 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 6 months there was no much difference in Lysholm score between both the groups (P =0.663) and at the end of 01 year aperture group had slightly better outcome. However, the difference was not statistically significant (p =0.173). There was more tunnel widening in the suspensory group especially of the femoral tunnel in the coronal plane. However, the amount of tunnel widening in both the groups was not significant statistically (P =0.071 and P =0.963). Tunnel widening is not associated with inferior clinical outcomes or functional knee score.</p><p><strong>Conclusions:</strong> Aperture and Suspensory fixation methods of hamstring graft at femoral condyle in ACL reconstruction are comparable clinically and there is no advantage of one particular method over other. Although comparatively more tunnel widening is seen in suspensory fixation methods; it does not affect the final clinical outcomes or functional knee scores. </p>

Functional outcome in arthroscopic anterior cruciate ligament reconstruction by suspensory fixation in comparison with aperture fixation method

“…While in the aperture fixation group (n = 20), it was 43.85±6.47 pre-operatively and 87.7±4.85 at the end of six months post-operatively. On intergroup comparison using independent t-test, aperture fixation was found to increase the Modified Tegner Lysholm Knee Score than suspensory fixation, which is in agreement with a study conducted by Kashid MR et al [8] However, the difference was not statistically significant. Modified Tegner Lysholm Knee Score has a significant role in assessing the improvement or deterioration of knee function and activity level.…”

“…When suspensory fixation and aperture fixation techniques were compared, as summarized in Table 2, the Modified Tegner Lysholm Knee Score was more effectively reduced with aperture fixation than with suspensory fixation at one month and six months post-operatively, but the difference was not statistically significant. Studies have demonstrated similar kinds of results with suspensory and aperture fixation techniques in the context of the improvement of Lysholm Knee Scores [8,13,24] . Ping et al conducted a prospective study using Lysholm, International Knee Documentation Committee (IKDC), and Larson scoring with an average follow up of 29.5 months and found no statistically significant scoring differences between groups at the end of follow up period, which is in accordance with our results [25] .…”

“…Many methods of surgical repair have been proposed for ACL reconstruction [7] . The ultimate goals of anterior cruciate ligament repair include a graft with low morbidity; excellent cosmesis, strength, and stiffness; and secure early fixation and incorporation near the joint Line [8] . Suspensory fixation (fixation of graft to bone at the lateral cortex of the femur) and aperture fixation (fixation of the graft to the bone through the tunnel at the joint level in the intercondylar notch) are the two widely used methods for graft fixation at the femoral end [9,10] .…”